Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surg...Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surgery.Methods:In 2019,fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan’s major referral heart institute.The patients were randomly assigned to either an intervention group or a control group.A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise(SDBRE)alongside the conventional care before CTR.The remaining 25 patients constituted the control group(50%)that had CTR following conventional care.The Visual Analogue Scale(VAS)was used to measure the participants’pain levels during three phases:before CTR(Time 1),5-min post CTR(Time 2),and 15-min post CTR(Time 2)to compare the intervention effect between the two groups.Results:The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups(H¼32.71,P<0.01;H=47.23,P<0.01)respectively.The intervention group had significantly lower pain levels than the control group at Time 2(3.50[1.20,5.30]vs.7.90[7.00,9.00],P<0.01)and Time 3(0.00[0.00,1.30]vs.3.60[2.40,4.10]P<0.01).Conclusions:Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.展开更多
BACKGROUND Traumatic hemothorax is a common complication of chest trauma;however,the timeline for its resolution,even with chest tube thoracostomy,remains unclear.AIM To determine the time to resolution of the hemotho...BACKGROUND Traumatic hemothorax is a common complication of chest trauma;however,the timeline for its resolution,even with chest tube thoracostomy,remains unclear.AIM To determine the time to resolution of the hemothorax to ensure safe discharge based on chest radiography(CXR)findings.METHODS A retrospective observational study was conducted at Hamad General Hospital,Qatar,from June 2014 to October 2019,including all patients with hemothorax diagnosed via computed tomography(CT)following chest trauma.Based on the initial imaging study,the hemothorax was divided into right,left,and bilateral.RESULTS The study included 422 patients.Of the total,57.82%(n=244/422)resolved their hemothorax within three days of admission.Among these,44 patients required chest tube insertion(CTI)and 200 were cleared without it.Between days 3 and 7,an additional 16.83%(n=71/422)of cases were resolved,of which 28 required chest tubes.By days 8 to 14,another 11.37%(n=48/422)were cleared,with 15 patients requiring chest tubes.After 14 days,13.98%(n=59/422)of patients still had hemothorax,14 of whom required CTI.CONCLUSION This study showed that a subset of patients continued to experience retained hemothorax despite early tube thoracostomy.Patients with a larger hemothorax,particularly on the left side,showed prolonged resolution times.Regular imaging such as CXR or CT is recommended for up to 14 days post-intervention.After this period,outpatient follow-up is generally safe,although some patients may still have a persistent hemothorax beyond two weeks.展开更多
Closed thoracic drainage can be performed using a steel-needle-guided chest tube to treat pleural effusion or pneumothorax in clinics.However,the puncture procedure during surgery is invisible,increasing the risk of s...Closed thoracic drainage can be performed using a steel-needle-guided chest tube to treat pleural effusion or pneumothorax in clinics.However,the puncture procedure during surgery is invisible,increasing the risk of surgical failure.Therefore,it is necessary to design a visualization system for closed thoracic drainage.Augmented reality(AR)technology can assist in visualizing the internal anatomical structure and determining the insertion point on the body surface.The structure of the currently used steel-needle-guided chest tube was modified by integrating it with an ultrafine diameter camera to provide real-time visualization of the puncture process.After simulation experiments,the overall registration error of the AR method was measured to be within(3.59±0.53)mm,indicating its potential for clinical application.The ultrafine diameter camera module and improved steel-needle-guided chest tube can timely reflect the position of the needle tip in the human body.A comparative experiment showed that video guidance could improve the safety of the puncture process compared to the traditional method.Finally,a qualitative evaluation of the usability of the system was conducted through a questionnaire.This system facilitates the visualization of closed thoracic drainage puncture procedure and pro-vides an implementation scheme to enhance the accuracy and safety of the operative step,which is conducive to reducing the learning curve and improving the proficiency of the doctors.展开更多
BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma...BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.展开更多
Objective:To explore risk factors for the development of pneumothorax in patients with COVID-19 during the second COVID-19 wave at a northern Indian level 2 health facility.Methods:Patients suffering from SARS-CoV-2 i...Objective:To explore risk factors for the development of pneumothorax in patients with COVID-19 during the second COVID-19 wave at a northern Indian level 2 health facility.Methods:Patients suffering from SARS-CoV-2 infection during the second wave of the COVID-19 pandemic in India(January-June 2021)at a tertiary care teaching hospital and level 2 COVID care facility were included.Cases who suffered from SARS-CoV-2 infection but did not develop pneumothorax were selected as matched controls.All details regarding demographics,clinical presentation,treatment,and outcome were recorded in a semi-structured proforma.Results:Eleven patients with COVID-19 developed pneumothorax during the study period and 40 controls were included in the study.Five cases were smokers in comparison to only two in the control group.Type 2 diabetes mellitus was the most common comorbidity among both groups.Median change in C-reactive protein overall for cases and controls were around+14.0 and-41.9 and was statistically significant.Conclusions:Inflammatory markers like C-reactive protein have significant correlations with the development of pneumothorax in COVID-19-infected patients.There is no sex predisposition to develop pneumothorax among patients with COVID-19.展开更多
Bilothorax or Cholethorax is the accumulation of bilious effusion in the thorax. It is a rare condition in which bile passes into the pleural space from the abdominal cavity, necessitating urgent treatment. This artic...Bilothorax or Cholethorax is the accumulation of bilious effusion in the thorax. It is a rare condition in which bile passes into the pleural space from the abdominal cavity, necessitating urgent treatment. This article aims to present a case of bilothorax treated successfully in our institute and review the literature on this topic to better understand this medical problem and the best ways of dealing with it. We presented in this article a case of bilothorax after an attempt of biliary drainage in a known pancreatic cancer patient and the way we managed it. We concluded about the importance of the early recognition of this medical problem and the necessity of aggressive and early management to prevent further morbidities and mortality.展开更多
Surgical complications after the transthoracic operation for esophageal cancer mainly include anastomatic fistula, gastric wound thoraco-stomach fistula, stenosis of anastomosis, perforation, gastric volvulus, diaphra...Surgical complications after the transthoracic operation for esophageal cancer mainly include anastomatic fistula, gastric wound thoraco-stomach fistula, stenosis of anastomosis, perforation, gastric volvulus, diaphragmatic hernia, infection, and some other pulmonary complications. Unfortunately, there are few reports about the complications caused by position change of the chest tube until now. We presented an unusual case of a patient who underwent a transthoracic operation for esophageal cancer in our department on August 17, 2006, and a lot of intragastric material was found in his chest tube 17 days later, endoscopic examination suggested that the chest tube had inserted into the stomach. We tried to discuss the etiology and clinical management for this case as well.展开更多
Objective: Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all traumarelated deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to expl...Objective: Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all traumarelated deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.Methods: A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury,injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.Results: There were 246 males ( 89.1%) and 30 females (10.9% ) ranging from 3 to 80 years with a mean age of (34 ± 17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1% ) and falling injuries (32 cases,11.6% ), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2% ) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.Conclusions: According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.展开更多
文摘Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surgery.Methods:In 2019,fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan’s major referral heart institute.The patients were randomly assigned to either an intervention group or a control group.A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise(SDBRE)alongside the conventional care before CTR.The remaining 25 patients constituted the control group(50%)that had CTR following conventional care.The Visual Analogue Scale(VAS)was used to measure the participants’pain levels during three phases:before CTR(Time 1),5-min post CTR(Time 2),and 15-min post CTR(Time 2)to compare the intervention effect between the two groups.Results:The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups(H¼32.71,P<0.01;H=47.23,P<0.01)respectively.The intervention group had significantly lower pain levels than the control group at Time 2(3.50[1.20,5.30]vs.7.90[7.00,9.00],P<0.01)and Time 3(0.00[0.00,1.30]vs.3.60[2.40,4.10]P<0.01).Conclusions:Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.
文摘BACKGROUND Traumatic hemothorax is a common complication of chest trauma;however,the timeline for its resolution,even with chest tube thoracostomy,remains unclear.AIM To determine the time to resolution of the hemothorax to ensure safe discharge based on chest radiography(CXR)findings.METHODS A retrospective observational study was conducted at Hamad General Hospital,Qatar,from June 2014 to October 2019,including all patients with hemothorax diagnosed via computed tomography(CT)following chest trauma.Based on the initial imaging study,the hemothorax was divided into right,left,and bilateral.RESULTS The study included 422 patients.Of the total,57.82%(n=244/422)resolved their hemothorax within three days of admission.Among these,44 patients required chest tube insertion(CTI)and 200 were cleared without it.Between days 3 and 7,an additional 16.83%(n=71/422)of cases were resolved,of which 28 required chest tubes.By days 8 to 14,another 11.37%(n=48/422)were cleared,with 15 patients requiring chest tubes.After 14 days,13.98%(n=59/422)of patients still had hemothorax,14 of whom required CTI.CONCLUSION This study showed that a subset of patients continued to experience retained hemothorax despite early tube thoracostomy.Patients with a larger hemothorax,particularly on the left side,showed prolonged resolution times.Regular imaging such as CXR or CT is recommended for up to 14 days post-intervention.After this period,outpatient follow-up is generally safe,although some patients may still have a persistent hemothorax beyond two weeks.
基金the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant(No.20172005)。
文摘Closed thoracic drainage can be performed using a steel-needle-guided chest tube to treat pleural effusion or pneumothorax in clinics.However,the puncture procedure during surgery is invisible,increasing the risk of surgical failure.Therefore,it is necessary to design a visualization system for closed thoracic drainage.Augmented reality(AR)technology can assist in visualizing the internal anatomical structure and determining the insertion point on the body surface.The structure of the currently used steel-needle-guided chest tube was modified by integrating it with an ultrafine diameter camera to provide real-time visualization of the puncture process.After simulation experiments,the overall registration error of the AR method was measured to be within(3.59±0.53)mm,indicating its potential for clinical application.The ultrafine diameter camera module and improved steel-needle-guided chest tube can timely reflect the position of the needle tip in the human body.A comparative experiment showed that video guidance could improve the safety of the puncture process compared to the traditional method.Finally,a qualitative evaluation of the usability of the system was conducted through a questionnaire.This system facilitates the visualization of closed thoracic drainage puncture procedure and pro-vides an implementation scheme to enhance the accuracy and safety of the operative step,which is conducive to reducing the learning curve and improving the proficiency of the doctors.
文摘BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.
文摘Objective:To explore risk factors for the development of pneumothorax in patients with COVID-19 during the second COVID-19 wave at a northern Indian level 2 health facility.Methods:Patients suffering from SARS-CoV-2 infection during the second wave of the COVID-19 pandemic in India(January-June 2021)at a tertiary care teaching hospital and level 2 COVID care facility were included.Cases who suffered from SARS-CoV-2 infection but did not develop pneumothorax were selected as matched controls.All details regarding demographics,clinical presentation,treatment,and outcome were recorded in a semi-structured proforma.Results:Eleven patients with COVID-19 developed pneumothorax during the study period and 40 controls were included in the study.Five cases were smokers in comparison to only two in the control group.Type 2 diabetes mellitus was the most common comorbidity among both groups.Median change in C-reactive protein overall for cases and controls were around+14.0 and-41.9 and was statistically significant.Conclusions:Inflammatory markers like C-reactive protein have significant correlations with the development of pneumothorax in COVID-19-infected patients.There is no sex predisposition to develop pneumothorax among patients with COVID-19.
文摘Bilothorax or Cholethorax is the accumulation of bilious effusion in the thorax. It is a rare condition in which bile passes into the pleural space from the abdominal cavity, necessitating urgent treatment. This article aims to present a case of bilothorax treated successfully in our institute and review the literature on this topic to better understand this medical problem and the best ways of dealing with it. We presented in this article a case of bilothorax after an attempt of biliary drainage in a known pancreatic cancer patient and the way we managed it. We concluded about the importance of the early recognition of this medical problem and the necessity of aggressive and early management to prevent further morbidities and mortality.
文摘Surgical complications after the transthoracic operation for esophageal cancer mainly include anastomatic fistula, gastric wound thoraco-stomach fistula, stenosis of anastomosis, perforation, gastric volvulus, diaphragmatic hernia, infection, and some other pulmonary complications. Unfortunately, there are few reports about the complications caused by position change of the chest tube until now. We presented an unusual case of a patient who underwent a transthoracic operation for esophageal cancer in our department on August 17, 2006, and a lot of intragastric material was found in his chest tube 17 days later, endoscopic examination suggested that the chest tube had inserted into the stomach. We tried to discuss the etiology and clinical management for this case as well.
文摘Objective: Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all traumarelated deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.Methods: A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury,injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.Results: There were 246 males ( 89.1%) and 30 females (10.9% ) ranging from 3 to 80 years with a mean age of (34 ± 17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1% ) and falling injuries (32 cases,11.6% ), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2% ) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.Conclusions: According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.
